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On Fri, 9 Dec 1994, J Shepherd wrote: > What Iain said, plus; > > Recompression treatment isn't just squeezing. The diagnosis and > correct schedule are important. Diagnosis, yes. "correct" schedule....well...I don't think there's any magical correctness to typical chamber schedules, other than the fact that they've been used a lot. We're talking MAJOR inexact science here. Besides, there are published "correct" schedules for IWR. > You swop 25mins on, 5mins off at 1bar > O2, but what about 1.6 bar O2? Why not? Can you swop under water? > It's done all the time. > How much improvement is there likely to be in the time available > (typically less than 30mins of O2 in a kit at 1bar)? You'd be VERY surprised. I've got information on cases that would make your skin crawl and conclude divine intervention must have taken place. In my own case, 7 minutes of breathing AIR at 10fsw reversed quickly progressing paralysis and eliminated all obvious symptoms for a subsequent half hour. When I entered the water, I was virtually quadriplegic. Without those 7 minutes, I am convinced I would not have ultimately recovered. > One poster has > mentioned 138 mins, but the bends that have occurred close to me have > been 4 to 6 hours at 2.6 bar O2 in a chamber (later compressions being > deeper and longer and usually not leading to complete relief of symptoms > :-( ). I would guess that's more a result of delay to recompression. There's very little information on how patients respond to DCI in a chamber when treated within 5-10 minutes of the onset of symptoms (doesn't happen very often). There seems to be growing evidence that time to recompression is of utmost importance in determining whether noticable permanent damage occurs. > Also, the schedules are shaped, just as a dive is. A descent, a > pause, and an ascent. All these factors have to be included in your > rapid hopover the side of a boat!! There are at least three published schedules, including detailed information on ascent rates, on IWR profiles. I follow a modified version of one of those. My ambition in making this topic public is to inform people that there IS quite a bit of useful information on IWR out there. My specific motivation is to reduce the number of cases where people just invent it as they hop over the side of the boat. The vast majority of reported IWR cases involve people who knew nothing about what they attempted, and who only used air. Although most of these yielded vast improvment, I think they'd have been even more successful if they had a better idea of what they were doing. > IMHO IWR is going to be useful only if the chamber is four hours > plus away, *and* you have someone capable of acting as a chamber > attendant and doctor, who can plan and execute recompression treatment. Sounds good to me. Like I've said in other posts, we all have to chose our own limits. BTW, I'd be willing to bet that more than half of all dives, and probably a huge majority of "technical" dives are conducted more than 4 hours away from a chamber (measured as time of onset of symptoms to time of recompression). > (NB, useful as a regular treatment advisable to most divers, as > opposed to the anecdotal reports of success that turn up). I'm not sure what you're referring to as "anecdotal". If you mean successful IWR attempts are anecdotal, well, I guess if you consider 500-600 cases (and those are just the ones that have been reported) as anecdotal... What I've found to be truely anecdotal are the 5 or 6 reported cases where IWR resulted in worsening the diver's condition. If you think the 100:1 ratio is a result of sampling bias, you're right...I've put a LOT more emphasis on finding information on UNsuccessful IWR attempts. The real ratio is probably more like 500:1. If there are more detrimental cases out there (and I am certain there are), my neverending requests for details are reaching the wrong ears (eyes?). > O2, treatment for shock and hysteria and correct radio drill - > followed by not fucking up when the chopper arrives; that gets my vote. Sounds great...if shock & hysteria are involved, emergency transport is an option, and that last criterium you mentioned is met.... > Once in trouble, steer clear of the water... it just complicates things. In many cases, it does. In other cases, it saves lives. Assessing a given situation and determining which sort of case it is is a vert difficult task. It can only help to learn as much as possible about the different options. If I sound snide, I sincerely apologize...I honestly didn't intend to. This subject is one of the very few that really gets me fired up.... Aloha, Rich deepreef@bi*.bi*.ha*.or*
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